Role of hysteroscopy in the diagnosis of uterine pathology in infertility in patients with familial Mediterranean fever

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OBJECTIVE

To evaluate the role of hysteroscopy in diagnosing uterine pathology in infertility in female patients with familial Mediterranean fever (FMF).

MATERIAL AND METHODS

An observational cohort study was conducted, in which a group of women (4577) of reproductive age (18—49 years) diagnosed with FMF was sequentially selected from the register of records and information collection of the Center for Medical Genetics for 1998—2018, including clinical, laboratory and genetic data of 32000 individuals of Armenian nationality examined for the presence of MEFV gene mutations. Three study groups were formed: 1st — (main) group — 211 patients with FMF aged 18 to 45 years (average 21.3 (6.4) years); comparison group (2nd group) — 127 patients with female genital tuberculosis (FGTB) aged 18 to 45 years (average 28.4±7.0 years; group 3 (control) — 162 patients with reproductive disorders without FMF and FGTB aged 18 to 49 years (mean 31.4±7.0 years). Hysteroscopy was performed in 45 patients with infertility in group 1, in 21 patients in group 2 and in 63 patients in the control group. The results were processed using the application package SPSS Statistics 21.0. Standard methods of determining the validity of diagnostic tests (sensitivity, specificity, predictive value of positive and negative test results) were used.

RESULTS

The most frequent hysteroscopic «findings» in patients with FMF were the following: chronic endometritis (CE — 48.9%), polyposis and endometrial hyperplasia (28.9%). The diagnosis of CE was verified by pathomorphologic and/or immunohistochemical methods in 15.6% of patients in group 1, 47.6% in group 2, and 30.2% in the control group (p=0.048). In group 2 women, hysteroscopic signs of CE combined with intrauterine synechiae were more frequent than in the control group (85.7% vs. 54.0%; p=0.045). The sensitivity and specificity of hysteroscopy in the diagnosis of CE in patients with SSL amounted to 15.6 and 72.7%, respectively; diagnostic accuracy — 47.0%, prognostic value of a positive result — 53.7%, prognostic value of a negative result — >31.8%. The sensitivity of hysteroscopy in the diagnosis of CE in patients with GSTB was 2 times higher — 37.0%, diagnostic accuracy — 75.0%, prognostic value of positive result — 78.2%, prognostic value of negative result — >55.6%. The sensitivity and specificity of hysteroscopy at CE in the control group respectively amounted to 30.2% and 45.9%, diagnostic accuracy — 36.0%, prognostic value of positive result — 33.3%, prognostic value of negative result — >55.9%. The simultaneous use of surgical method to eliminate the cervical and uterine factor of infertility was effective in 76.9% of patients with SSL, in 85.0% — in the control group and in 55.6% — in GSTB.

CONCLUSION

The frequency and structure of uterine pathology in patients with SSL are comparable with those in the control group. Low sensitivity of hysteroscopy in the diagnosis of CE indicates the need to combine it with pathomorphologic and immunohistochemical studies. Hysteroresectoscopy is an effective method of uterine pathology treatment in patients with FMF and in the control group its efficiency is reduced to 55.6% in GSTB.

Keywords:

familial Mediterranean fever

hysteroscopy

infertility

female genital tuberculosis

endometrial polyposis

chronic endometritis

hysterororesectoscopy

Authors:

Sotskiy P.O.

Center of Medical Genetics and Primary Health Care

ORCID: 0000-0002-9679-1681

Received:

17.04.2023

Accepted:

18.05.2023

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